Rulemaking Hearing Rules of The Tennessee Department of Commerce and Insurance Insurance Division. Chapter
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1 Page 1 of 5 pages. Rulemaking Hearing Rules of The Tennessee Department of Commerce and Insurance Insurance Division Chapter Medical and Professional Malpractice Claims and Expenses Reporting Table of Contents Purpose and Scope Definitions Annual Claims Data Submission Requirement Format for Submitted Data Penalty Rule Purpose and Scope. The following rules developed by the Department of Commerce and Insurance govern the reporting of medical or professional malpractice claims and expenses. The purpose of these rules is to facilitate the reporting required by T.C.A Rule Definitions. (1) Chiropractor means an individual licensed pursuant to Title 63, Chapter 4. (2) Clinical Pastoral Counselor means an individual certified pursuant to Title 63, Chapter 22, Part 2. (3) Closed Claims means claims that have been paid pursuant to a settlement or judgment, including, claims that were settled or adjudicated with the condition of open medical treatment to the claimant. (4) Commissioner means the Commissioner of the Department of Commerce and Insurance. (5) Dentist means an individual licensed pursuant to Title 63, Chapter 5. (6) Department means the Tennessee Department of Commerce and Insurance. (7) Licensed Clinical Social Worker means an individual licensed pursuant to Title 63, Chapter 23. (8) Marital and Family Therapist means an individual licensed pursuant to Title 63, Chapter 22, Part 1. (9) Medical or Osteopathic Physician means an individual licensed pursuant to Title 63, Chapter 6 or Chapter 9. (10) Nurse Practitioner means an individual that holds a certificate of fitness issued pursuant to Title 63, Chapter 7, Section 123. (11) Optometrist means an individual licensed pursuant to Title 63, Chapter 8. (12) Pharmacist means an individual licensed pursuant to Title 63, Chapter 10.
2 Page 2 of 5 pages. (13) Physician Assistant means an individual licensed pursuant to Title 63, Chapter 19. (14) Podiatrist means an individual licensed pursuant to Title 63, Chapter 3. (15) Professional Counselor means an individual licensed pursuant to Title 63, Chapter 22, Part 1. (16) Pending Claims means claims that have not been paid pursuant to a settlement or judgment but have been made known to the reporting entity either by a lawsuit or some other manner. (17) Person means an individual or business entity. (18) Reporting entity means the following: (a) (b) Every insurance company or risk retention group providing medical malpractice insurance or professional liability insurance to a Tennessee health care institution licensed under Title 68. Every insurance company or risk retention group providing medical malpractice insurance or professional liability insurance to any of the following: 1. Podiatrists; 2. Chiropractors; 3. Dentists; 4. Medical and Osteopathic Physicians; 5. Nurse Practitioners; 6. Optometrists; 7. Psychologists; 8. Pharmacists; 9. Physician Assistants; 10. Professional Counselors; 11. Marital and Family Therapists; 12. Clinical Pastoral Counselors; and 13. Licensed Clinical Social Workers. (c) Every health care institution licensed pursuant to Title 68, or professional listed in this Rule, except the state and those employed by the state, who does not maintain professional liability insurance.
3 Page 3 of 5 pages. Rule Annual Claims Data Submission Requirement. (1) All reporting entities shall submit to the Commissioner by April 1 of every year, a claims data file containing all information required by this Chapter for medical or professional malpractice claims and expenses for the period of January 1 though December 31 of the preceding year. (2) The claims data file shall contain the following data as set forth and explained in more detail in Appendix A listed by type of provider and indication of specialty, if any: (a) claim being filed; (b) (c) (d) Date of occurrence of the event that resulted in a medical or professional malpractice Claimant s social security number; License number of health care institution or provider; The damages asserted by the claimant listed separately as follows: 1. Damages asserted by the claimant other than amounts asserted by a lawsuit; and 2. Damages asserted by the claimant through a lawsuit. (e) The amounts paid on claims listed separately as follows: 1. Amounts paid by the reporting entity to settle a claim; and 2. Amounts paid by the reporting entity pursuant to a judgment. (f) The amounts paid on claims shall be listed separately by the following types of damages: 1. Punitive damages; 2. Compensatory damages; and 3. Non economic damages paid by the reporting entity. (g) (h) The deductible amount that was not paid by the insurance company or risk retention group; The amounts paid on claims shall be listed separately by the following types of expenses: 1. Amounts paid to attorneys for defense counsel, excluding amounts paid for expert witness fees, court costs, deposition costs, and other costs; 2. Amount of the settlement or judgment that is received by claimant s counsel; 3. Amounts paid for expert witness fees; 4. Amounts paid in court costs; 5. Amounts paid in deposition costs; and 6. Amounts paid in connection with other legal expenses not previously identified.
4 Page 4 of 5 pages. (3) The second and subsequent reports filed by April 1 of each year pursuant to this Chapter by each reporting entity shall also contain information identifying those claims that are subject to settlement or judgment which were contained in a prior report as a pending claim. Rule Format for Submitted Data. (1) All data submitted to the Commissioner on the claims data file shall be submitted in both electronic format and on a CD in the form created by the Commissioner. (2) All data located in columns shall be in alpha numeric format unless otherwise stated. When using numeric data, only regular decimal formats will be acceptable. No compressed or binary (small integer or large integer) data will be accepted as valid. (3) All date data shall be Gregorian USA format with a four (4) digit year (MM/DD/YYYY). This means a two (2) digit month (with leading zeros when necessary), a slash (/), a two (2) digit day (with leading zeros when necessary), a slash (/), and a four (4) digit year. (4) All currency data shall be in units of U.S. dollars rounded to the nearest whole dollar amount. Leading zeros and the dollars signs are not necessary but may be used so long as the currency fields are consistent. Authority: Tenn. Code Ann Rule Penalty. Any reporting entity that fails to comply with the provisions of this Chapter shall be subject to a civil penalty of one hundred dollars ($100) per day. APPENDIX A Pending Claims Date of Occurrence Claimant s Social Security Number License Number Asserted Damages (other than set forth in lawsuits) Damages Claimed by Lawsuit Closed Claims This should contain information for pending claims that have been asserted through a lawsuit or by other means. This should not include information on claims that have been paid pursuant to a settlement or judgment. This should be the date on which the incident arose that gave rise to the medical or professional malpractice claim. This should be for the person making the claim. This should be the health care institution or provider s license or certificate number. This should include an amount that has been asserted against a reporting entity in a manner other than by filing a lawsuit. This should include the amount of damages asserted against a reporting entity in a lawsuit. This should contain information for claims that have been paid pursuant to a settlement or judgment, including claims that were settled or adjudicated with the condition of open medical treatment for the claimant.
5 Page 5 of 5 pages. Amount Paid by Settlement Amount Paid by Judgment Punitive Damages Paid Compensatory Damages Paid Non Economic Damages Paid Total Damages Paid Deductible Amount Attorney Fees Paid to Defense Counsel Portion of Settlement or Judgment Received by Claimant s Counsel Expert Witness Fees Court Costs Deposition Cost Other Legal Fees Total Legal Expenses Grand Total Claims Paid This should include the total amount paid pursuant to a settlement between the reporting entity and the claimant. This should include the total amount paid pursuant to a judgment against the reporting entity. judgment that was identified as punitive damages. judgment that was identified as compensatory damages. judgment that was identified as non economic damages. judgment that was the sum total of punitive, compensatory and non economic damages. This should include the deductible amount that was not paid by the insurance company or the risk retention group. This should include the amount that was paid to defend the medical or professional malpractice claim. This should not include the expense related to expert witness fees, court costs, deposition costs, and other legal expenses. This should include the portion of the settlement or judgment that the claimant s counsel received for their services. This should include the expert witness fees that were expended by the reporting entity. This should include the court costs that were expended by the reporting entity. This should include the deposition costs that were expended by the reporting entity. This should include any other legal fees not specifically identified that were expended by the reporting entity. This should include the legal fees that were expended by the reporting entity, including the claimant s attorney fees. This should include the total amount that was paid on a claim including the amount of settlement or judgment and the total legal expenses expended by the reporting entity, including the claimant s attorney fees. Legal Contact and/ or party who will approve final copy: Tracey Gentry Harney Staff Attorney Department of Commerce and Insurance Fifth Floor, Davy Crockett Tower 500 James Robertson Parkway
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